Evan P Nadler1, Barbara A Gaines. 1. Division of Pediatric Surgery, Department of Surgery, New York University School of Medicine, New York, New York 10016, USA. evan.nadler@med.nyu.edu
Abstract
BACKGROUND: The Surgical Infection Society published their most recent recommendations for antimicrobial therapy in patients with intra-abdominal infections in 2002. These guidelines outlined several important considerations for the treatment of such infections, including which patients require antimicrobial agents, the appropriate duration of treatment, which antimicrobial regimens are appropriate, and the risk factors and indications for intensified regimens. However, the applicability of these recommendations to the pediatric population is not entirely clear. METHODS: Systematic review of all literature regarding antimicrobial therapy in the most common intra-abdominal infection in children, appendicitis, with the goal of establishing guidelines for use. RESULTS: Children with uncomplicated (acute or gangrenous), but not perforated, appendicitis can be treated with prophylactic antimicrobial agents for 24 h or less. Children with perforated appendicitis can be treated after appendectomy in the same manner as adults with established intra-abdominal infections; i.e., with therapeutic antibiotics until no clinical evidence of infection exists. This is true after both laparoscopic and open operations. Whereas "triple" antibiotic therapy has been the gold standard in pediatric patients, monotherapy with broad-spectrum agents is equally effective and possibly more cost-effective. The nonoperative management of perforated appendicitis with interval appendectomy represents a unique problem, and guidelines for therapy are less well established. CONCLUSIONS: The evidence supports using guidelines in the pediatric population similar to those suggested for the adult population for the management of acute appendicitis.
BACKGROUND: The Surgical Infection Society published their most recent recommendations for antimicrobial therapy in patients with intra-abdominal infections in 2002. These guidelines outlined several important considerations for the treatment of such infections, including which patients require antimicrobial agents, the appropriate duration of treatment, which antimicrobial regimens are appropriate, and the risk factors and indications for intensified regimens. However, the applicability of these recommendations to the pediatric population is not entirely clear. METHODS: Systematic review of all literature regarding antimicrobial therapy in the most common intra-abdominal infection in children, appendicitis, with the goal of establishing guidelines for use. RESULTS:Children with uncomplicated (acute or gangrenous), but not perforated, appendicitis can be treated with prophylactic antimicrobial agents for 24 h or less. Children with perforated appendicitis can be treated after appendectomy in the same manner as adults with established intra-abdominal infections; i.e., with therapeutic antibiotics until no clinical evidence of infection exists. This is true after both laparoscopic and open operations. Whereas "triple" antibiotic therapy has been the gold standard in pediatric patients, monotherapy with broad-spectrum agents is equally effective and possibly more cost-effective. The nonoperative management of perforated appendicitis with interval appendectomy represents a unique problem, and guidelines for therapy are less well established. CONCLUSIONS: The evidence supports using guidelines in the pediatric population similar to those suggested for the adult population for the management of acute appendicitis.